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Two hundred and fifty-six consecutive new patients seen in the weekly burns outpatient clinic were questioned, concerning details of their injury and first aid measures taken, and the information was recorded on a questionnaire. Following computer analysis, an interesting pattern of incidence, susceptible age groups, 'danger zones', and first aid given in the community emerged. Conclusions regarding burn prevention and first aid have been drawn.

Background: Cardiac siderosis from transfused iron remains the major cause of death in thalassaemia major, despite iron chelation therapy with desferrioxamine. Aims: Our aim was to determine the nature and extent of cardiac involvement and its relationship to desferrioxamine use in a group with thalassaemia major. Methods: We reviewed 76 patients with thalassaemia major and performed multiple logistic regression to analyse factors affecting cardiac involvement. Factors studied included: patient sex, age, haemoglobin, serum ferritin, total transfusions, liver iron, duration of desferrioxamine use, electrocardiograms, echocardiograms and compliance to desferrioxamine treatment. Results: Thirty-seven patients developed heart disease. They were older (p < 0.001), began desferrioxamine later (p < 0.001), had more liver iron (p= 0.014), higher serum ferritin levels (p= 0.023) and received more blood (p = 0.018). Compared to those with optimal compliance the odds of developing heart disease were increased 10.7 times in fair compilers (p

Combination chemotherapy with cytosine arabinoside, cyclophosphamide and L-asparaginase (Asnase) was given to 22 children with acute lymphocytic leukaemia (ALL) with a white-cell count greater than 30 X 10(9)/1, and other features suggestive of poor prognosis. Complete remission was induced in all patients--in 19 after 2 courses of chemotherapy and in the remainder after a third course. During induction, neutropenia occurred in 18 and severe infection in 3. Anaphylaxis to Asnase occurred in 8 patients after the second course and one other had transient Asnase-induced diabetes. All patients received central-nervous-system prophylaxis after achieving remission, during which they were also treated with weekly vincristine and a 2-week course of prednisolone. Continuation therapy consisted of short cycles of intermittent chemotherapy and BCG inoculation or long cycles of intermittent chemotherapy +/- BCG. Life-table analysis shows 46% complete remission rate at 28 months, with 6 patients all in complete remission followed up between 28 and 41 months. There were minimal complications of continuation therapy, and BCG inoculation was well tolerated.

Feery, B. J., Matthews, R. N., Evered, M. G., and Gallichio, H. A. (1979).Aust. Paediatr. J., 15, 177–180. Antibody responses to influenza virus vaccine in children with acute lymphocytic leukaemia. Antibody responses to influenza immunization in children with acute lymphocytic leukaemia in remission were studied in two successive years. Initial antibody levels, the response to immunization, and final antibody levels were lower than in a group of children with cystic fibrosis. The results indicate that both primary and anamnestic antibody responses are depressed in children with acute leukaemia when they are on immunosuppressive therapy. Despite this depression the majority of the patients reached protective antibody levels to the A/Victoria/3/75 and A/Texas/1/77 (H3N2) antigens but not to the recent A/USSR/90/77 (H1N1) antigens.

Twelve children with acute lymphocytic leukemia who had been in complete remission on continuous chemotherapy for at least 12 months, were treated with intermittent courses of chemotherapy alternating with BCG inoculation during the drug-free intervals. Measurements were made of leukocyte populations in blood and bone marrow leukemic blastogenic responses of blood lymphoid cells to phytohemmagglutinin and soluble leukemic blast cell membrane antigen. Antibody titers to a soluble leukemic blast-cell membrane-derived antigen were determined. Comparison was made with similar measurements during a second phase of intermittent chemotherapy without BCG inoculation (phase II). Two children showed bone-marrow relapse and two developed central nervous system leukemia during the study. Rises in blood and bone-marrow lymphoid cell numbers were found during both phases of the study. Blastogenic responses to phytohemagglutinin, depressed at the start of the study following at least 12 months of continuous chemotherapy, rose during intermittent chemotherapy and BCG and remained within normal ranges during phase II. Antibody titers and blastogenic responses to leukemia blast-cell membrane antigens increased in eight of twelve and six of seven children respectively during the BCG phase and were maintained during phase II. Only one child showed further increases in phase II. The combination of BCG and intermittent chemotherapy may increase leukemia-associated immunity in some patients with acute lymphocytic leukemia in remission. The separate contributions of either BCG or intermittent chemotherapy in producing this effect cannot be determined by this study.

From 1972 to 1977, 55 of 161 children with acute lymphocytic leukaemia discontinued treatment after being in continuous complete remission for three years. A low total white cell count as diagnosis (less than 10 X 10(9)/L) was significantly associated with cessation of therapy, but there was no significant association with age or sex. Nine patients have relapsed, all but one within 50 weeks of cessation of treatment. Testicular relapse occurred only in one patient. Actuarial complete remission rate with a median duration of follow-up 140 weeks was 76%, and there was no significant sex difference. It is proposed that the relatively good prognosis in boys after cessation of therapy may be related to limited use of steroids during induction chemotherapy.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.

Continuation therapy using intermittent chemotherapy and BCG inoculation was commenced in 28 children with acute lymphocytic leukemia (ALL) immediately after remission induction and "CNS prophylaxis." At a median followup time of 17 months, 71% remain in total remission and 86% in bone marrow remission. Complications of the therapy were minimal. Major infections occurred on two occasions and there were no deaths in remission. Neutropenia, "minor" infections and postponement of chemotherapy occurred most often during the first three courses of treatment. There were no local or systemic BCG infections. Tuberculin sensitivity was tested in 25 patients. It was positive in 17 of 18 patients in total remission and all four patients with only CNS relapse, and was negative prior to relapse in three patients who developed bone marrow disease.

Results of treatment in 72 children with a relapse of acute lymphoblastic leukaemia were analysed. A second remission was induced in 57 children (79%). Remission rates were significantly higher in males, and in patients with white cell counts less than 30 X 10(9)/L. The median duration of the second remission was only four months, and the median duration of survival from the time of relapse was nine months. The median duration of survival from the time of diagnosis was 27 months. Among children who suffered a relapse was a small group who had prolonged survival and prolonged second remissions. It is uncertain whether some of these may have a chance of "cure".

Treatment of acute myeloid leukaemia in children. C. M. Paton, H. Ekert, K. D. Waters, R. N. Matthews and I. R. G. Toogood, Aust. N.Z. J. Med., 1982, 12, pp. 143–146. Complete remission was achieved in 11 of 22 children with acute myeloid leukaemia using at least two courses of a 24 hour infusion of cytosine arabinoside (Ara–C) 10 mg/kg, followed by push injections of daunorubicin (DNR) 45 mglm2, and adriamycin (ADR) 45 mglm2. Consolidation therapy consisted of three courses of Ara–C and 6–thioguanine (Tg) and one course of cyclophosphamide (CPA) and ADR. Central nervous system prophylaxis with intrathecal Ara–C was given in all patients and cranial irradiation in five. Maintenance therapy consisted of 5 day courses of Ara–C and Tg given 4 weekly with immunotherapy (BCG vaccine and subcutaneous leukaemic cells) between courses. Median length of first complete remission was 99+ weeks, and median survival of all patients was 44 weeks. Median survival of remitters was 195+ weeks and non–remitters, 28 weeks. Two patients developed central nervous system disease, one at presentation and the other 46 weeks from presentation. Five patients have ceased therapy and remain in remission from 32 to 142 weeks after ceasing treatment.